Entries in patient education
(13)

The National Cancer Institute reports 2017 U.S. cancer care expenditures were $147+ billion, with anticipated increases from our aging population.

According to Deloitte’s report in Evidence Based Oncology ( The American Journal of Managed Care publication), many organizations are exploring ways to control costs and enhance care quality for oncology patients (e.g. Patient Centered Medical Homes, CMS’ Oncology Care Model).

With many different types of cancer and treatment options, each patient embarks on a personal care journey.

Oncology patients often experience a long journey. Although some steps entail engaging with care staff at a hospital or clinic, most of the time patients are challenged with managing their disease on a daily basis away from the health system.

Healthcare organizations need to closely monitor oncology patients to determine when care and support is required. To be proactive and stay aligned with patient needs, health systems must collect patient information (e.g. Patient Reported Outcomes/PROMs, Patient reported experiences/PREMs). This patient information can guide the care team to intervene, reducing hospitalizations and costs.

“A few years ago, we successfully used a patient engagement care tool with our palliative patients. Our palliative team is embedded within Oncology. Eighteenmonths ago, we introduced this telehealth type of application to our oncology patients. We felt it would be valuable to extend TapCloud to our general oncology patients because we had seen such a positive response using it for those with high symptom burden and advance disease. We believe many patients and caregivers will benefit from having this tool available to use”.

Patient Experience

How does TapCloud support the oncology patient? What is the patient experience?

Last month, Robert (not his real name), a 77 year old patient was diagnosed with prostate cancer. Dr. Twaddle and her staff worked closely with Robert through the onboarding process to provide an overview, demonstrate how to use TapCloud, help him download the TapCloud app onto his phone and iPad and discuss what symptoms they will manage to personalize the app for his specific condition.

The Nurse Coordinator explained “Robert, with this tool (TapCloud), we can think about you when you are not in front of us, get a sense of how you are doing and that we are on the same page”. Robert was relieved to get a message from his Nurse Coordinator confirming that she can see Robert listed on the dashboard to keep a close eye on him.

Most of Dr. Twaddle’s seventy active patients using the TapCloud App are in their 60s and 70s, with a few in their 80s and 90s.

Through the TapCloud app Care Plan, patients like Robert are asked a set of questions. How are you feeling today compared with yesterday? Which of these meds are you taking? Which symptoms are you experiencing today? Symptoms that were selected the prior day are displayed bold. Patients can add symptom(s) which typically takes less than a minute to provide this critical information.

Symptom tracking is made easy by using a word cloud. Each day, the patient sees a personalized word cloud containing symptoms. This personalized symptom cloud incorporates his condition and medications and his list is continuously enhanced from machine learning. TapCloud’s predictive symptoms cover 100+ conditions and 14,000+ side effects. The patient simply touches those symptoms he is noticing. Additionally, he views personalized education based on his journey stage (e.g. tips for managing chemo side effects) and what he is experiencing. He can also upload this biometric information (e.g. vitals, etc.).

How has Northwestern Medicine used the TapCloud tool to deliver better care to Oncology Patients?

Dashboard displays demo data only

Prioritize Patient Outreach. The TapCloud platform analyzes all the patient clinical and self- reported data in real time. Using advanced algorithms, patients with a clinical need are identified and alerts are sent to the care team. Patients are prioritized based on alerts, severity and risk. Nurses use theTapCloud Triage Dashboardto efficiently track, monitor and respond to patients requiring an intervention. Nurses can drill down on a specific patient to see how many days since check in, recent events (e.g. vitals, medication usage), pain and anxiety levels.

Intervene on specific symptoms: Instead of “fishing” for information about how a patient is feeling or having the patient end up in the ER, Nurse Terri can call the patient and say “I've noticed that you've had increased pain the past 2 days…”. TapCloud can also be set up to send alerts for symptoms associated with a patient’s treatment. Patients can send a picture within the TapCloud app with a secure message about their concern.

In the Patient’s Words: “We had one patient who didn’t feel pain but entered ‘yuk’. He selected that to communicate in his words what he was feeling. One of the features that I really like is journaling. A patient may share that today he is ‘discouraged by his illness’. Although he does not expect us to respond, it gives us insight into how he is doing and the support that he may need from us”, shares Dr. Twaddle.

Stay Connected with patients who do not come in regularly: When patients are going through infusion treatment, Dr. Twaddle explained that her team sees them on a frequent basis. “However, when our patients are on oral chemo, we feel that TapCloud is especially valuable to give us a window into their experience. We risk losing them because they cannot tolerate the medications and stop without communicating to us.”

Address Patient Needs with Right Resource: When patients are not in the Clinic or Hospital, it is important to understand what they need. “We may see in a patient’s journaling that she is feeling afraid which is not physical but may be best addressed through our psych- social resource. Or a patient may be ‘running out of her medication’ or ‘checking in on an upcoming appointment’, which can be managed by our Nurse Coordinator."

Measuring Success

Dr. Twaddle uses a set of quantitative and qualitative measures to evaluate the success for the TapCloud solution for oncology patients including:

1) Patient Engagement. How involved are patients in participating in their care? How often did they check in with the app? Which symptoms are most common? What are the new symptoms that have been added by the patient?

3) Cost reduction. How much money was saved by avoiding ER through interventions on symptoms? “When one of our cancer patient ends up in the ER, we explain that we may be able to help avoid the admission with a check in on the TapCloud tool. We had one patient with a side effect that we could have spotted and intervened since it was dangerous for her”.

“We have found that TapCloud is helpful both with cancer patients who have declining function (e.g. pancreatic, advanced lung, brain tumor) and with those that may be curable (e.g. head & neck, breast)", shares Dr. Twaddle.

AMITA Health’s Program will leverage TapCloud

AMITA Health, one of Illinois’s largest health systems is in the process of planning their program which will use TapCloud.

“When I first heard about TapCloud, I was on board immediately”, explains Dr. Robert O. Maganini, Breast Cancer Specialist at AMITA Health. “We have a compliance problem with our breast cancer patients. Although the hormone therapy treatment (e.g. Tamoxifen, Class Aromatase inhibitor) is for five years, some patients will stop after two years because of the side effects. Our working theory is if we have insights into where these patients struggle and when, we can do more aggressive interventions instead of waiting for their next appointment”.

“Our plan is to offer TapCloud to all 200 patients who want to use it, from newly diagnosed to those in year two when we experience a drop in treatment adherence”. After describing his patient population – mostly women 40-75 years old, Dr. Maganini expects a high opt- in rate since it is “ideal for them because it enables faster and more convenient access to their provider”.

Like Dr. Twaddle, Dr. Maganini is planning to use a patient- centric approach when introducing TapCloud, ensuring that patients understand why they are using TapCloud, how to use it, and when to use it.

Dr. Maganini plans to introduce TapCloud to patients at the time of diagnosis. Nurses (e.g. NPs, Navigators) will get patients set up and show them how to use the digital health application. “Since surgery is typically the first step, we plan to use as a follow up with discharge instructions. For those in going through chemo treatments, we will monitor their symptoms. We want to get our patients accustomed to using TapCloud and then they will be using it for the long run with hormone therapy”.

As part of the planning process, Dr. Maganini is working with his team to define the list of side effects including the words that these patients use to describe them. He is leveraging his own and his nursing staff’s patient experiences to devise the TapCloud symptom list in “patient speak”. This is helpful to patients who often struggle to describe their symptoms and feelings.

From this program, Dr. Managini expects to learn about the top side effects, interventions and the effectiveness of the interventions. He will be looking at different success factors – “increase in the therapy completion (3, 4, 5 years) and longer term (beyond the 2 years) hopefully a decrease in mortality rate and reoccurrence”.

“With a program showing demonstrative effectiveness, we envision scaling this to the AMITA Health 2.0, 19 hospitals”, concludes Dr. Managini.

Throughout the recent Connected Health Conference, the key theme was the need to balance technology with the human element.

Northwell Health, New York’s large integrated health system with 22 hospitals and 550+ outpatient facilities, recognizes the importance of leveraging technology to extend the care team and personalize the patient journey.

With the launch Northwell Health Chats (powered by Conversa Health), patients are empowered to connect, communicate and collaborate with their care team, while their clinicians closely monitor the patient’s evolving needs.

Think about a patient’s journey today. Pamela, a 78 year old Medicare patient has just been discharged from a Northwell Hospital for a heart failure episode.

Fortunately for Pamela, Northwell’s Health Chats, a new conversational AI platform will help support her during her recovery. With this text based chatbot, Pamela receives many more outreaches from her care team, a three- fold increase from about five times to fifteen during the 30 days post discharge period.

When she returns home, Pamela starts receiving notifications through SMS text message and clicks on the link to begin her chat about how she is doing. These chats continue to support Pamela through her recovery.

Pamela is asked to confirm her weight uploaded automatically from her Withings scale. She sees her weight trending map with an educational message about working towards her goal. Next, Pamela responds how she is doing with her leg swelling and then about any difficulty breathing.

Finally, the chat asks Pamela to indicate any side effects of her new medication. Based on her responses, she may be connected with her nurse to discuss any medication adjustments. All of the information that Pamela provided to the chatbot is shared with her nurse for their discussion.

Since this patient engagement solution is seamlessly integrated into Northwell’s work flow (e.g. care management tool/HIE), Pamela receives these personalized chats from her specific Nurse Navigator at Northwell and the chat content is tailored for her specific care journey. Pamela trusts the information that she receives and can respond with questions and concerns at any time. Pamela’s Nurse Navigator will determine if she needs to come right in to the office or if they can address her issues through a text, email, call or telehealth visit.

Northwell is leveraging their Health Chats for population health. For example, the chat support patients as they prepare for a colonoscopy in their own language, ensuring the patient understands the instructions and knows how important this screening is to their health. This chat helps increase the patient’s health literacy and confirms that the patient knows how to prepare, reducing delays in diagnosis and additional health costs.

Positive Results with Northwell Health Chats

Sabina Zak, VP Northwell Community Health believes this chatbot is a “way to engage patients, by embedding information that is accurate, actionable and enables them to make more informed decisions which leads to better outcomes”.

As Northwell rolls out their Health Chats across the enterprise, they will be monitoring care quality, care cost and patient satisfaction measures. With Northwell Health Chats, they are seeing a 97% patient satisfaction rate and lower post-acute care expenses in some of its hospitals. Northwell management is particularity interested in the reduced costs from fewer outreach calls since the bot engages patients and brings back needed information.

Patient Comment:

“These conversations were great and supportive emotionally as well as medically”.

Nurse Leader Comment:

“Conversa gives me reassurance that my patients are ok because I can see that they are responding to the health chats. It gives me piece of mind knowing that they are alright without having to always call them.”

In addition to supporting patients through procedures such as Colonoscopies, Northwell will be using this conversational chatbot to gather social determinants of health before the patient’s annual office visit. This information will be shared with their care team for their appointment.

Beyond population health, Northwell is expanding their Health Chats into Oncology, starting with head and neck and expanding to breast and prostate cancer patients. Northwell’s Health Chats will help patients prepare for the treatment, manage symptoms and check in once the treatment has concluded.

In the future, Northwell is planning to use their Health Chats in the areas of bundled payments for patients with Coronary Artery bypass, Acute MI, Pneumonia, Stroke and Heart Failure.

During the Voice.Health Summit in Boston last week, innovators gathered to explore opportunities, discuss issues and to experience different voice technology use cases.

BCH John Brownstein shares voice health use casesJohn Brownstein, Chief Innovation Officer at Boston Children’s Hospital is excited about the opportunity for healthcare to lead other verticals with this empowering technology which many of us use every day – Alexa tell me… Siri what is… ?

Since the year 2000, the health technology industry has evolved from websites (e.g. patient portals) to mobile applications (mhealth) and now to voice and conversational assistants. There are many use cases which help patients and providers in different settings.

In hospital, the doctor asks to see the patient’s latest lab results.

Following a hospital discharge, the patient interacts with his virtual robot to record side effects from his new medications.

Preparing for an outpatient visit, a patientverbally responds to the pre-visit questions to share with her doctor.

Days aftera remote monitoring visit,a patient asks additional questions to help her manage her asthma.

Although voice health technology is in the early adoption stage, health innovators are convinced that these virtual voice assistants can address real problems -- the shortage of healthcare professionals, clinician burn out, inefficiencies in patient care, lack of patient engagement and the inability to personally support patients along their health journey outside of the hospital. Nuance’s Peter Durlach stresses the importance of using these technologies to free up the clinicians to take care of patients.

Voice has many unique benefits for healthcare. Dr. Rupal Patel, CEO VocalID describes the convenience (e.g. hands free), the capability to capture information and insights about the user (e.g. gender, size, bio- markers) and ability to generate trust through continuous listening and personalized responses. Other benefits include the ability to capture context (e.g. surroundings, urgency and intent) and empower the user (e.g. patient feels a sense of control). Amazon’s Emily Roberts, Sr. Marketing Manager adds the value of capturing “moments of the day” by incorporating voice into other devices (e.g. smart home/refrigerator, car).

Voice Health in Action

During the Voice.Health Summit, we saw what “voice-first” can deliver in five different care setting exhibits. Here are some interesting examples of use cases to bring value to patients and/or the care team.

1. Hospital/Patient. With the Joint Commission’s focus on “accurate screening and assessment of pain”, Dr. Samir Tulebaev, Geriatrician and the Center of Nursing Excellence at Brigham and Women’s Hospital are working with Orbita’s CEO Nate Treloar on the development of a post- operative pain management voice assistant. The patient tells her bedside teddy bear Briggie (which has a built in microphone) that she is in pain, describes where the pain is and indicates if the pain is intolerable. Her nurse immediately receives a secure text message to respond.

2. Hospital/Clinical. Cedars-Sinai uses Sopris Assistant to record, summarize, approve and place the patient care note into the EHR. The AI summons the listening technology, drives the summary and produces the intelligent note for physicians. Cedars-Sinai helped Sopris Health create an experience and workflow catered to hospitalist.

3. Senior Living & Home Health. Caregivers can engage an aging patient with the AI powered LifePod virtual assistant which serves as a personalized companion, delivers reminders, and monitors daily activities. LifePod’s CEO Stuart Patterson emphasized the importance of “proactive voice” which shares and captures essential information without relying on the person to ask (i.e. reactive voice).

4. Consumer Home.Anne Weiler, CEOWellpepper, the winner of the Alexa Diabetes Challenge, engages a patient who is recently diagnosed with type 2 Diabetes. She uses her voice to weigh herself, scan her feet for ulcers and track her care plan tasks. This voice assistant gives the patient an opportunity to proactively engage whenever she wants.

As with any new technology, there is a lot to learn from the pioneers.

Real Problem Definition: Sara Holoubek, CEO Luminary Labs emphasized the importance of deciding who (e.g. newly diagnosed) and what (e.g. help with self-management) as a first step to focus the development planning process.

Patient/User Input: Deloitte's Debbie Hays,Specialist Executive discussed the patient journey research for the DeloitteASSIST voice solution which revealed the “challenges and delays” that needed to be addressed while the patient is in the hospital room.

Patient/User Feedback: Karin Beckstrom, Sr. Product Manager ERT Innovation Lab (formally PHT) described using voice to capture patient reported outcomes (PROs) on a daily basis. We ask-- how engaging was it? Are you willing to answer questions on a daily basis? How difficult was the skill? Did Alexa understand you?

"Flu Doctor" from Seattle Children's Hospital Stacey UlaciaPersonalization: Stacey Ulacia, Sr. Communications Specialist at Seattle Children’s Hospital in partnership with Boston Children’s Hospital, developed the “Flu Doctor” voice skill. This brings more value since it is customized based on the zip code provided by the patient.

Opportunities for Voice to Solve Healthcare Problems

There are many use cases for voice technology to help drive the triple aim.

UPMC’s Dr. Shivdev Raobelieves it would be valuable to use voice to help triage a care situation, and capture information from the patient pre or post exam.

Boston Children’s HospitalDr. Docktor shared Pediatrics Voice Hackathon examples including one which uses voice to help a patient prepare for his procedure at home with instructions and images that are tailored to his specific health issues (e.g. food problems).

Cedars-Sinai Medical Center in Los Angeles is collaborating with Sumeet Bhalitia, Founder & CEO Aviato bring voice into the hospital room, giving the patient control over their experience and the ability to get assistance as needed (e.g. bathroom help) with the goal of increased patient satisfaction.

Recent metrics for Answers by CignaCigna’sLaura Schuntermann, Global Head of Digital Strategy & Partnerships is excited by the growth of voice search. Gartner predicts by 2020, 30% of searches will be voice activated. Laura shared results from the voice solution Answers by Cigna which helps members get the information they need to make better health care decisions.

Although there is excitement around voice health, innovators are working to remove speed bumps to accelerate adoption:

Addressing Privacy/Security. Several organizations are anxiously awaiting for HIPAA compliant voice devices. There is also a concern that the device is always listening, even without the “wake” word.

Educating Patients about Voice. A fewpresenters admitted that patients do not know what they can ask. This means that either they are not using all of the voice capabilities or the patient has an unexpected experience -- Alexa says …. Hmm I do not know that one.

Mayo Clinic's Optimizing Voice Content Creating complete Patient Experiences. Mayo Clinic’s Jennifer Warner, Sr Editor Global Business Solutions explains that voice is additive and does not replace other consumer engagement methods. Therefore, it is important to provide an “omni-channel” experience to engage and support the patient through every touch point.

Collaborating on Care Design. Maia Ottenstein, Digital Experience Design at Thomas Jefferson University Hospital (DICE/design group within the hospital) is working on the “smart patient concierge” which empowers the patient to access assistance and resources on demand.

It will take a community of patient and clinical stakeholders to define, design and deliver voice technologies that bring real value to the users. It is encouraging to see that these stakeholders are coming together in hospitals, accelerators and innovation hubs to bring these voice technologies to life.

With the shift to value- based care, health systems are investing in mobile technologies to increase patient engagement and care quality while reducing the cost of care delivery.

Geisinger, an award winning healthcare system based in the Mid-Atlantic with 12 hospitals and a 510K+ health plan, is a leader in patient engagement. Within their organization, the Geisinger in Motion team focuses on strategic initiatives to drive patient engagement by co-creating with patients on digital technology solution design, capabilities and efficacy.

Last fall, the Geisinger in Motion team embarked on a project to enhance their patient education resources, which spans all three patient engagement strategies. Although they already offered a comprehensive set of patient education materials (i.e. handouts, online resources, targeted classes, individual conversations), Geisinger was looking to expand the reach of these resources for patients and their families.

“The genesis of the idea came from a pilot for patients that were having Lumbar Spine surgery”, explains Chanin Wendling, AVP, Geisinger in Motion. Geisinger focused on this patient population because of the prevalence back pain problems across the nation, the volume of surgeries done annually (approximately 2,000) and high patient co-pays for the surgery.

“For this pilot, we loaded 10 iPads with educational content and loaned them to patients for about 4 months during the time before and after surgery”, Wendling shares. “After the pilot, we realized that we needed to come up with a different approach. CMS prevented us from giving the iPads to their patients, a critical population that we didn’t want to exclude. In addition, it was very expensive to have enough iPads for all patients and took a lot of work to get the iPads back.”

From the pilot, Geisinger also learned that patients wanted to use a device with everything on it. After evaluating different mobile tools, Geisinger elected to use Apple’s iBook and iTunes University to conveniently package a set of patient resources in one place and enable patients and their families to easily access and consume education content when needed, pre and post- surgery.

Geisinger began by bringing together existing components into the iBook. ”We had built a number of tools over time and were trying to leverage what we had to deliver a full ‘patient engagement package’ solution”, adds Wendling.

MySurgery: Lumbar Spine reminder mobile app – Developed for the iPad loan pilot, this app reminds the patient of activities that need to be done pre and post- surgery

Health (electronic) questionnaires for Lumbar Spine outcomes & medication reconciliation – These have been in place for a several years

Patient Education Experience & Engagement

When Geisinger patient Lisa decides to have lumbar spine surgery, she receives a handout explaining how to use her mobile device (iPhone, iPad) to access a suite of patient engagement tools through iTunes University or to download an iBook. Lisa’s friends and family can also access the educational materials to help her throughout surgery prep and recovery. The handout instructs Lisa to contact the Nurse Navigators listed with any questions.

Patient Lisa engages electronically with these educational resources which contain animations, videos and interactive components. She moves through the chapters covering “meeting the care team”, “learning about the surgery”, “diet and medication guidelines”, “what to do before surgery”, “what to expect day of and after surgery” and even ”Navigating the Geisinger Medical Center”.

Within the course, patient Lisa is encouraged to download the Lumbar Spine App to receive reminders about pre and post- surgery activities such as diet and medication requirements, what to expect during the hospital stay, things to watch for post- surgery (e.g. fever), how to address pain, exercise and sexual activity. Three and twelve months after surgery, Lisa receives a notification and logs into her patient portal to complete health questionnaires about her Lumbar Spine recovery outcomes and medication. All of the information that Lisa enters flows into the EMR so that the care team can monitor her recovery.

“We have received very positive response from our patients who like accessing these resources all in one place. It helps by setting expectations, reinforces materials discussed at clinic visits, reminds them of important steps and gives them a reference to share with family and friends. Since the 3 month visit tends to be difficult to schedule and not all providers feel it is necessary, the questionnaire responses let the team check in with the patient and follow-up if there is a need”, describes Wendling.

Geisinger has expanded this education offering beyond Lumber Spine with iBooks for Pediatric Concussion and NICU (for parents). “Pediatrics was the initial area for our IPS project (iPads while patients are in the hospital). We learned about the high-volume of print materials that are handed out in the NICU and realized that we needed to give parents a better tool”, Wendling explains.

The Geisinger in Motion & IT teams continue to tackle resource issues and have "more ideas than we can execute”. Currently, they are working through a set of operational issues for tracking and measurement:

Activity Tracking-Fitbit/Withings: Although it was part of iPad pilot (e.g. 10 patients were given a Fitbit), it is not currently in iTunes University. “We are waiting on a project where the ability to get patient generated health data from wearables will be available in the patient portal and then can automatically be uploaded into the EMR”, Wendling shares.

Measurement: “We completed and posted the Lumbar Spine course in December with an access code but then had to work with Apple to get qualified as an education institution in order to make it available publicly. From iTunes University, there have been about 30 downloads of the Lumbar Spine, 20 downloads of each of the NICU books and 16 of the Concussion. This is a public system so it is really hard to determine who is downloading. We are using survey data to better understand the profile of our users”, Wendling adds.

In the future, Geisinger plans to bring out bariatric surgery education through iBook and iTunes University. “Obesity is a significant health issue in Pennsylvania and the components around healthy weight and eating can also be used for other conditions such as diabetes, heart failure and hypertension. We hope this will be a building block as we expand our education resources to support patients and families”, concludes Wendling.

WELLBE PLATFORM FOR PATIENT ENGAGEMENTWith an aging population and increase in chronic conditions including obesity, the demand for hip and knee operation is increasing dramatically. A study in the Journal of Bone & Joint Surgery estimates by 2030 “demand for total hip arthroplasties to grow by 174% to 572,000 and demand for primary total knee arthroplasties by 673% to 3.48 million procedures”.

Responding to this strong demand and high procedure expense, CMS launched the Comprehensive Care for Joint Replacement (CJR) payment bundle April 1st, focusing on cost and quality over a 90-day period beginning with the hospital admission. The CMS CJR Payment bundle is initially for about 800 selected hospitals across the country.

Although Virtua, one of New Jersey’s largest health systems with hospitals, surgical and rehabilitation centers, is voluntarily participating in the BPCI payment bundle, their investment in the orthopedic patient experience at their Joint Replacement Institute (JRI) started long before the payment model changes.

Virtua Health’s Orthopedic Patient Care Journey

Back in 2000, Virtua adopted the Six Sigma methodology and launched the STAR initiative to deliver an "outstanding patient experience”.

“When we look at how we can change and improve a process, we focus on the patient and understand what they need, not what we think they need,” explains Kate Gillespie, AVP of Virtua’s Orthopedic Service Line.

With a commitment to enhancing the orthopedic (hip, knee) surgery experience, Virtua listened to patients discuss their challenges and needs. Through focus group research (Spring 2015), Virtua learned:

• Orthopedic patients need a lot of information to get ready for their surgery but are overwhelmed when inundated with too much at one time.

• Patients place a high value on their doctor’s suggestions to achieve best results.

• Patients that are prepared are more confident and will participate in the process leading to improved outcomes.

“We learned that as patients prepared for surgery, they were asked many of the same questions by different members of our care team,” said Gillespie. “We needed to improve the patient experience and ensure the consistency of information shared along the patient journey. We also wanted to engage the family to support the patient before and after surgery and decided to require that each patient has a ‘care partner’.”

The Virtua JRI team looked for technology to continuously engage patients and families, from on-boarding before surgery, to educating and guiding them from discharge through recovery. The tool needed to be actionable, collecting essential information from the patient (i.e. concerns, pain levels) and informing Nurse Navigators when patients fall off track.

Virtua JRI chose to implement a Connected CarePath for Total Joint Replacement from Wellbe, a solution provider in Madison, Wisconsin. Working closely with Wellbe, Virtua customized their CarePath with their own health history and sleep apnea surveys, scheduling and care plan content (delivered via “CareCards”).

Patient Journey

PATIENT CREATES CARECIRCLE ON WELLBEDuring the initial visit to the surgeon’s office, patient Patty is given information about Wellbe, a personalized care plan for her pre-and post-surgical journey. She signs up with the Nurse Navigator and receives a Welcome email. Patty shares this information and invites her family ‘Care Partner’ to join her CareCircle to access her resources.

Pre- Surgery: Beginning 4-6 weeks prior to surgery, Patty views a care plan with a personalized set of “CareCards” explaining the operation and process to successfully prepare including preadmissions testing and health clearance forms. She receives a “CareCard” introduction to her Nurse Navigator. Every CareCard is delivered “from” her doctor or another member of her care team to motivate compliance. Patty receives reminder messages and checklist items leading up to the surgery and can refer to any completed CareCards in the “library” such as “How to prepare for the day of surgery.”

“Our patients really like the library feature. Before we launched the Wellbe platform, patients were given a Joint Replacement booklet. Now patients and families have all the surgery information at their fingertips. Patients traveling to our Institute can prepare for their surgery by viewing videos instead of attending an in-person class,” adds Gillespie.

Post –Surgery: Within Wellbe, Patty views discharge information such as symptoms to watch for and completes surveys so that her care team can manage her recovery. Patty’s Nurse Navigator monitors her “Progress Report” with required actions and contacts her with any concerns.

“We believe this post-surgery engagement is important to prevent readmissions by ensuring the patient understands how to take medications, manage pain and follow outpatient physical therapy,” Gillespie shares.

Patient Engagement Results

Since launching the Wellbe platform in December 2015, Virtua JRI has enrolled 700 patients. Patients span every socio-economic level and range from 40- 90 years old, with the majority in their 70s.

“We are signing up 86% of our surgery patients which is much higher than we expected. The remaining patients either did not have an email address or didn’t have a friend or family member to help them,” explains Gillespie.

Virtua is evaluating success based on a few factors. Through a Wellbe survey, they are measuring how prepared the patient feels using the platform. With Wellbe reporting, Virtua is also measuring the patient’s engagement and compliance with required CareCards.

Patients have shared positive comments about their experience using the tool - “grateful for the support received”. Nurse Navigators have also provided feedback - the Wellbe platform has helped them be more efficient in their patient care. Through “one tool”, nurses are able to “organize and track patient progress and communicate with the rest of the team” (i.e. physician office, pre-admission testing department).

Virtua has received suggested enhancements such as “defining an end time for a patient to be on the platform” and removing the medication form since patients “already gave the medication list to my surgeon.” Virtua has also added a link to the “Virtua Orthopedic Endowment”, giving patients an opportunity to give back.

Future Opportunities

Virtua initially launched the Wellbe platform without tying it into their Electronic Medical Record. “We are considering integrating Wellbe into our EMR so that the patient’s surgical chart will be easily available on one site for our Nurse Navigator.”

“Wellbe provides a key to patient engagement by keeping them engaged and participating towards a successful surgical journey. Virtua is determining where we can use this tool in other service lines such as Spine, Bariatric, Oncology and Maternity, which are all education-intensive clinical episodes.”

“This program aligns with our vision in keeping our focus on the patient /family experience, and provides us with an opportunities to participate in their surgical journey”, Gillespie concludes.